Provider Demographics
NPI:1427369131
Name:MEJEVOI, NICOLAI G (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAI
Middle Name:G
Last Name:MEJEVOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3340 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8088
Mailing Address - Country:US
Mailing Address - Phone:941-764-5858
Mailing Address - Fax:941-764-1657
Practice Address - Street 1:3340 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8088
Practice Address - Country:US
Practice Address - Phone:941-764-5858
Practice Address - Fax:941-764-1657
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036125985207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease